Thrombocytopenia (TTP / ITP)
INFORMATION FOR WOMEN WITH TTP WHILE PREGNANT OR BREASTFEEDING
What is TTP?
TTP stands for thrombotic thrombocytopenic purpura, which is a blood vessel problem that can develop occasionally during pregnancy, as a complication of certain diseases, or independently of any condition. A person who has TTP experiences both blood clotting and bleeding; normally, these are opposite problems, but bleeding and clotting occur together in TTP, because platelets (specially clotting cells) form numerous clots by clumping together with on another and with a certain protein. The platelets are consumed in the process, which then makes it harder to form clots, so the person bleeds. Normally, the actions of a certain enzyme (a substance that helps chemical reactions work inside organisms) prevents this chain of events, but certain diseases, and also pregnancy, can affect the workings of that enzyme.
If you develop TTP, you will notice a lot of bruising, plus bleeding, especially in the nose, gums, and from cuts. Your stools may appear dark, because they contain blood, and your urine may be rose-colored, also because of blood. You may also experience extreme fatigue, pain in the side or around your tummy, headaches, seizures, confusion, trouble breathing, nausea, vomiting, diarrhea, lack of appetite, and various other symptoms.
How common is TTP during pregnancy?
Although TTP is overall fairly rare in society, about half of all severe, quickly-developing cases in women of child-bearing age occur during pregnancy.
How is TTP during pregnancy diagnosed?
Usually, TTP must be a clinical diagnosis, meaning that the doctor decides that you probably have TTP based on bruising, bleeding, and certain other symptoms developing very quickly (over one to a few days), and by results of simple, quick blood and urine tests, particularly the finding that the number of platelets in your blood is too low, and that there are pieces of broken red blood cells in your urine. It is also possible to test the activity of the specific enzyme that does not work well in TTP. This would provide a definite laboratory diagnosis for TTP, but usually there is not enough time to await the results of this test.
Does TTP cause problems during pregnancy?
If TTP is not recognized quickly and treated, it is fatal in 9 out of 10 cases. However, recovery is likely if you receive a treatment called plasma exchange.
Does TTP during pregnancy cause problems for the baby?
TTP can destroy the fetus within your uterus, resulting in miscarriage. It also can cause a spontaneous abortion (miscarriage) without first destroying the fetus (or earlier in pregnancy the embryo). TTP can also cause what doctors call intrauterine growth retardation, which can end the pregnancy, or produce a newborn with low birth weight.
What to consider about taking medications when you are pregnant or breastfeeding:
- Any risks to yourself and your baby if you do not treat the TTP.
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat TTP during pregnancy?
The main medications that may be given as part of treatment for TTP related to pregnancy are called corticosteroids. When given intravenously, the usual steroid is called called methylprednisolone, whereas a similar drug called prednisolone is given by mouth. Both of these drugs are considered safe for the fetus.
Who should NOT stop taking medication for TTP during pregnancy?
Since TTP is a life-threatening emergency, there is no scenario in which corticosteroids must be withheld on account of pregnancy.
What should I know about choosing a medication for my TTP during pregnancy?
You may find Pregistrys expert reports about the individual medications used to treat TTP here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my TTP when I am breastfeeding?
Prednisolone, the corticosteroid that is given by mouth, is considered safe in mothers who are breastfeeding. The corticosteroid that is given intravenously is called methylprednisolone and there is some concern that it enters breast milk. Mothers requiring methylprednisolone might be able to breastfeed if they pump and discard milk that that has accumulated for a few hours following an intravenous methylprednisolone dose, then feed the infant on milk that builds up later. This procedure is fairly complex, however, and so a safer option would be to use infant formula.
What alternative therapies besides medications can I use to treat my TTP during pregnancy?
The main treatment for TTP during pregnancy is plasma exchange, which is not a medication. Patients also may require transfusions of red blood cells, which also is not a drug treatment.
What can I do for myself and my baby when I have TTP during pregnancy?
Anybody suspected of having TTP, in the Emergency Department or your doctors office, will be admitted to the hospital immediately, so there is really no decision for you to make.
Resources for TTP in pregnancy:
For more information about TTP during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles: